Prisoner of Paradise (2003) is a very different film about film. It profiles Kurt Gerron, the successful German-Jewish cabaret performer, actor, and director whose career was destroyed and who was ultimately deported to Theresienstadt – the Nazis’ fake model Jewish city – where just before the end of the war he was conscripted to write and direct a fake documentary presenting the miserable ghetto as a joyous, comfortable place.

I have some problems with the film. Overall, it’s rather workmanlike; there’s really no compelling artistic thread holding it together, and Gerron’s story – bringing together theater, film, comedy, celebrity, artistic careers, truth, community, and propaganda – offers a wealth of artistic raw material. There’s also not enough about Gerron as a person or an artist. The film repeats again and again how central Gerron’s work was to him and his identity, but no sustained treatment of his comedic or directorial vision is provided. Nor is there sufficient contextual information about the Nazis’ attacks on theater and film, and especially on Jewish people working in these fields. (The stories of Gerron and several other Jewish theater and film professionals are, by the way, told in Dead Funny, which I’ve discussed here in the past.) This superficial treatment almost leaves the viewer with the sense that Gerron’s choices were based simply on arrogance and a sense of superiority.

This is compounded by the film’s portrayal of Gerron’s life in Europe before his arrest by the Nazis in the Netherlands. It’s presented as a series of opportunities to escape that were lost due to Gerron’s own decisions, which the film doesn’t consider in any depth. That presentation tends to manipulate the viewer into a sick 20/20-hindsight victim-blaming game – “Why didn’t he get on the ship to the US?!” “Why didn’t he hire a boat in Holland to get him away?!” – which singles Gerron out and holds him responsible for his victimization. While the film is generally sympathetic, I think this lends itself to appalling readings, like this from the Hollywood Reporter review: "[I]t tells a morality tale of a man whose hubris partially led to his downfall and whose willingness to work for his Nazi overseers [!] resulted in one of the most notorious propaganda films of the era."

So, despite the fact that the interviews are definitely worth watching and Gerron’s story should be known, I don’t know if I can fully recommend this one. By all means, though, do see Granito.

Thursday, June 28, 2012

At long last, on July 1st, the state’s ban on foie gras will take effect. Appetite for Justice has the history behind the law, featuring a discussion of the risks and frustrations of working through legislative channels (and an adorable duck photo!).

When it’s come to confronting attitudes and beliefs I saw as damaging amongst the activist, 'progressive' movements to which I belong, I’ve often been hesitant and timid. A lot less open in my opposition, and a lot more likely to simply 'agree to disagree', leave subjects alone and untouched. There’s a lot of fear in that. Perhaps I’m scared of being hated. Perhaps I’m scared of losing friends. Perhaps I’m scared of alienating my allies, scared of falling out of any wider movement and no longer having a community to belong to. Scared of belonging to nothing, to no one, no longer being a part of anything beyond myself. Scared of ending up an isolated misanthrope, fighting a lonely angry war, with no one left I’m actually fighting for. Standing for nothing except pride and a stubborn adherence to inflexible, abstracted principles.

These are of course valid, as are her reasons for working to overcome those fears – that she’s also “scared of allowing my participation in activism to be defined by compromise, and of my principles ultimately deteriorating to nothing more than a vague adherence to a certain 'side' of a certain dialectic ideological conflict that no longer has much of anything to do with what I actually believe in. Just cheering for my team, no matter what they’ve come to stand for,” of “ending up blindly supporting an ideology that is going to end up hurting people.”

I don’t mean for a second to minimize such personal reasons, with which I don’t disagree, but as this is something I’ve been struggling with since before I became a blogger,** I thought I’d take the opportunity to talk about a few complications that attend criticizing woo and anti-science on the left. It’s important to bear in mind both the political context in which such criticisms are made as well as how the hierarchical social relations that characterize this context shape people’s thinking. It’s only by appreciating this that we can most fully judge the potential effects of our criticisms and thoughtfully consider the best course of action in each case.

The first complication is that there exists a tendency, when an example of woo on the left is raised, for people to extend the connection between the group(s) and the belief well beyond the original claim. This is the case more generally: mention is made of the existence of misogyny amongst some gay men, for example, and many minds jump to the idea that gay men have some particular predilection for misogyny. It’s very natural for people, especially those hostile to the aims of a social justice movement, to let individual examples of woo color their view of the movement as a whole and jump to dismiss it as anti-science.

This makes discussing examples of bad thinking or ideas amongst social justice advocates somewhat fraught. If you point, say, to a few examples of gender essentialist thinking among feminists, or, worse, discuss the problem of gender essentialist thinking within feminism in the abstract without offering specific examples, it’s quite likely that anti-feminists and even many would-be allies and feminists themselves will form a mental link between feminism and gender essentialism (and ignore, of course, that patriarchal systems are founded fundamentally in essentialist thinking, of which feminist gender essentialism is merely the mirror image, and that feminism has overwhelmingly been about challenging essentialist beliefs). Or, to take another example, the existence of the notion that animal rights activists anthropomorphize nonhuman animals, despite the reams of species-specific evidence from animal rights organizations and nuanced views about anthropomorphism, will lead many people to latch onto isolated examples of invalid anthropomorphism and dismiss activists’ arguments. It’s convenient for those who don’t want to think about the physical or emotional suffering of animals to be presented with such examples.

Stereotyped thinking about marginalized groups in this context is not just a human tendency. It’s exploited opportunistically by those in power, and corporations have a long history of slapping the “anti-science” label on their critics. They do this by pointing to real examples and generalizing from these to an entire movement as discussed just above, by portraying all activists’ concerns as identical to those of the wooists, and by misrepresenting evidence-based challenges as woo. Industrial agriculture conglomerates are especially adept at this, as is the psychiatric drug industry. Those who oppose policies centered on GE foods and industrial agriculture are routinely painted as anti-science health kooks, and those pointing to the weaknesses of the brain-disease model of mental disturbance are regularly claimed to be denying that mental suffering exists or that the brain is involved, even despite clear evidence to the contrary.

Insofar as they identify science with that which claims the label, and particularly the understandings promoted by corporations and the powerful in general, skeptics often act as the unwitting (or in some cases willful) accomplices of conservatism. Epistemically, we often treat movements from below unjustly, focusing on a few failures of skeptical thinking to discount a person’s, organization’s, or movement’s claims entirely, whether the woo is purely incidental or fundamental to their main arguments and whether or not these arguments are otherwise strong.

Recently, the Mad in America site – which features a number of voices and arguments, of generally uneven quality – invited a “holistic psychiatrist” to post there, who apparently will be talking about such useful and well-founded ideas as chakras and energy fields. I’ve been torn about mentioning it here because I’ve seen the dynamic play out over and over when radical criticisms of psychiatry are raised: people tend to look for reasons to discount the criticisms without engaging with them, and often even the most tangential will suffice. (I’m still uncertain if mentioning it here is the right thing to do. I’ve made an effort for months now to encourage people hostile to these ideas to read books like Joanna Moncrieff’s The Myth of the Chemical Cure, and I fear this single wooish connection of one web site, otherwise containing much sound and important information, will give people a rationale to avoid those critical voices. That would be unskeptical and unfair. We should make more of an effort to engage with fact claims that make us uneasy or don’t fit with our cultural presuppositions, and maintain a sense of proportion about errors or lapses in judgment that aren’t pertinent to consistent and well-evidenced arguments.)

Another complication is that wooish ideas often contain insights. We shouldn’t ignore these insights simply because they’re not presented in the language of science (and we shouldn’t always assume that claims are wholly non-metaphorical and non-strategic). For instance, I’m ambivalent about publicly challenging some things - the recognition of Pachamama in the Bolivian and Ecuadoran constitutions, the suggestion that eating meat is eating suffering, or some cultural understandings of mental distress - without extensive caveats and contextualization. I appreciate these ideas, understood metaphorically, in ethical and aesthetic terms. But I believe also that these notions contain insights about the world and our place in it that are lacking in my own instrumental, exploitative, alienated, unsustainable culture.

This isn’t always the case, and of course I’m not suggesting that all understandings are equally valid or anything like it. As Ethan Watters points out with regard to beliefs about mental disturbances:

I have tried to avoid making the clichéd argument that other, more traditional cultures necessarily have it right when it comes to treating mental illness. All cultures struggle with these intractable diseases [sic] with varying degrees of compassion and cruelty, equanimity and fear. My point is not that they necessarily have it right—only that they have it different. (Crazy Like Us, p. 254)

(I should note that the brain disease model of contemporary psychiatry is woefully uninsightful about human distress and unhelpful when it comes to addressing it; in fact, as I’ve discussed before, it marginalizes the insights of other perspectives.) Further, recognizing these insights doesn’t require or entail accepting the belief system in which they’re found or its epistemic basis. (This is complicated by my firm stance against religious and wooish beliefs forming the basis for any social activism, as I’ll discuss in more depth in a future post.)

In psychiatry as in some other areas, it’s not a matter of science vs. woo or anti-science but of various mythologies, one of them (the brain-disease model) claiming the status of science. Reed calls on people to recognize that in addition to science our culture has its own mythologies and superstitions, but we also need to acknowledge, I think, that many of our myths masquerade as, and are widely accepted as, science. We should be careful when distinguishing between disinterested science and politically motivated ideology, since when doing so we run the risk of supporting what is in actuality a more harmful set of beliefs and practices simply because it’s widely accepted in our culture as scientific.

So calling out woo in social justice movements is complicated by a tendency to generalize from specific examples, stereotype movements, and dismiss well-supported arguments; the opportunistic exploitation of these tendencies by corporations and other powerful entities; the desire to look for reasons to ignore uncomfortable arguments or reject them out of hand; the insights that might be found in "unscientific" sets of beliefs; and the mythological character of some beliefs claimed to be scientific. Arguing that this should all form part of decisions about challenging bad ideas in social justice movements is not arguing that we therefore should never challenge them - on the contrary I do so regularly. But it's complicated, I’m generally unsure as to whether I’m making the right decision about calling it out or not in any particular instance, and it tends to nag at me forever whichever way I decide to go.

*There’s a lot to this post, and I don’t necessarily agree with all of it, but I do agree with quite a bit.

Wednesday, June 27, 2012

It seems HuffPo will feature deconstructive work on corporate-dominated medicine, but not if it includes challenges to its alternative darlings (in this case, ECT, which is only "alternative" in the sense that today it's not in the medical mainstream, though it was in the past).

Unquestionably, medicine plays a huge role in securing children's rights. Indeed, the Convention on the Rights of the Child is clear that children have the rights to survival, development, and the highest attainable standard of health, all of which must be respected if they are to fully enjoy the wide range of rights under the Convention. Medical assistance is hence vital to the fulfilment of all children's rights, and prescription drugs are often an important component of health care.

But what happens when the very same companies that provide life-saving drugs violate some children's rights to improve health care for others, or simply to increase the bottom line? As the pharmaceutical industry becomes increasingly globalised, it is ever more important to ask this question. Over the past several years, lawsuits and investigations have cropped up around the world that raise concerns about not only testing drugs on children, but administering untested or unnecessary drugs on children.

+++

While pharmaceutical companies have the power to greatly increase children's well-being, it is difficult to see how this can be accomplished by conducting unsafe and unregulated trials, prescribing untested medicine as a matter of course, and lobbying to give some children medication they don't need while seeking to deny others the medication they do need. These practices threaten rather than enhance children's rights to survival, development and health, and CRIN firmly believes that they must be put to an end. As the business of medicine expands around the world, its focus must be fundamentally revisited and revised in light of global ethical concerns and, above all else, the pharmaceutical industry should realign its focus to ensure that its efforts are in the best interests of all children.

Of course, the pharmaceutical industry is never going to realign its focus, and this is why no part of health care should be in the hands of a private, for-profit industry in the first place, but it’s a good thing that children’s rights activists are calling for major reforms in this area.

(The Buenos Aires Herald reported that the government found that the 14 babies who died were in the placebo group and that the vaccine is safe; while of course important to note - if correct - this shouldn’t distract from the documented abuses in this research.)

What caught my attention was that the CRIN editorial links to an article from January about how GSK was appealing the decision. I had actually heard about the case in April, when I came across reports that GSK was dropping its appeals and paying the fines, so I knew this information was dated. I searched for more recent coverage, and came up with page after page of reports from January about GSK’s appeal, giving the impression that all was still up in the air. The only reason I was able to find the April article, which is in Spanish, was that I’d saved it at the time. I suspect that there were few or no major exposes or stories in the mainstream English-language media reporting on the April developments, but is it also possible that they do exist but GSK is using some SEO techniques to bury them?

Another case mentioned in one of the editorials is that of Florida’s Department of Juvenile Justice**:

Last year, Florida ordered a sweeping investigation after finding that many psychiatrists engaged to treat children in the juvenile justice system had accepted large fees from manufacturers of antipsychotic medications. Child advocates have argued that the rising and widespread use of these powerful drugs, some of which are not even approved for use in children, is little more than a “chemical restraint” on children.

But when I try to find recent news about the progress, findings, reports, or consequences of this “sweeping investigation,” I come up empty-handed.

This could be a search failure on my part, but I think these two cases are indicative of the way in which patterns of corporate/government abuse in research and psychiatry not only overwhelmingly go unreported, except for those few egregious examples in which people have made noise, but on the rare occasions these examples do appear they're then allowed by the media to fade into obscurity.

*This phrasing reflects the reality of law with regard to corporations in most places at present. It’s a sad fact that corporations can be found guilty of serious crimes and pay fines without any human having to take criminal responsibility. In fact, the top executives are oftenrewarded.

I Got Better is an ongoing project defying the all-too-common message that recovery from mental and emotional distress is impossible. The I Got Better campaign will make stories of recovery and hope in mental health widely available through a variety of media.

"[T]his is basically an issue that reflects the craven, cruel nature of the Republican Party on Capitol Hill, but it also reflects the caution, the cowardliness, the betrayal of the Democratic Party of its core constituency. Historically, this would be a no-brainer. This would be on the platform."

Wednesday, June 20, 2012

Here’s the short list of recommendations I promised in my previous post. These are generally written for a popular audience. As I’ve said in the past, they’re not uniformly perfect in every way – in fact, they don’t all agree with one another on every issue. But taken together they provide a solid overview of the contemporary criticism of psychiatry from various angles, as well as numerous references for further reading in specific areas. Also relevant is my series on Erich Fromm and this list, which I’ve barely begun to dig through.

(Goldacre has a new book coming out in the fall, in the UK at least, called…well, I thought it was The Drug Pushers, but it might now be Medicine is Broken. Neither of these focuses exclusively on psychiatric drugs.)

I realize that all of the books I’ve mentioned are by men. Next on my own list is Joanna Moncrieff’s The Myth of the Chemical Cure (no Kindle version, so harder to get)

and some works on the history, anthropology, and sociology of specific “conditions.”

The first reason is corporate involvement with the scientific research and the dissemination of psychiatric ideas. It’s difficult to think of any area of knowledge in which corporations exert more power than they do in psychiatry. They sponsor drug trials, they market the drugs and the model on a massive scale, they lavish vast sums on influential psychiatrists and academic research centers and sponsor professional bodies and advocacy groups, they put their spinon textbooks, they shape which results are published and which are not, they control access to knowledge about drug research, they influence media coverage,…

Related to this, the corporations lie. Beyond all manner of research and publication chicanery, they have lied about research outcomes. They’ve been taken to court and paid billions in fines, which of course are but a small fraction of the profits they’ve made on the drugs in question. And they’re organized. PhRMA is a union of these organizations, all of which, despite competition amongst them, have a strong interest in perpetuating the disease model and the story about the drugs’ effectiveness.

Despite this, and of course very significant in terms of skepticism, the evidence that the model is baseless and wrong and that drugs are ineffective and harmful continues to mount, coming from many sources (including the companies’ own clinical trials and the admissions of even the drug advocates). Called to answer demands from various groups and organizations to show that the biopsychiatric model is supported by evidence and that the drugs that are being administered to people – often coercively – are effective and safe, the corporations and the psychiatric community have repeatedly demurred. Many people have even gone so far as to suggest that a scientific approach isn’t needed in this case - that anecdotes and judgments based on clinical experience are sufficient. The corporations have wisely decided that, in general, ignoring scientific criticisms and calls for evidence is the best response, and that’s worked well for them. But skeptics should be hammering them on this.

Challenges to psychiatry are frequently greeted with the sorts of responses that are rejected when they’re made by CAM supporters or, more apt in this case, religious defenders. This is a thorny issue because people really are suffering and struggling with problems, many people believe the drugs have helped or could help them or their loved ones biochemically (I’ll talk more about this in a later post), and the large placebo effect shown in research on antidepressants complicates matters. But skeptics can’t accept such anecdotes as the basis for evaluating a drug’s effectiveness or risks, and should be very suspicious of any alleged treatment for which clinical or anecdotal experience is a preferred defense against evidence-based challenges.

Another aspect of psychiatry that opens it up to challenges from skeptics and justice advocates is its history. Examining the institutional, social, and political history of psychiatric beliefs and treatments is essential to understanding psychiatry today. The more we understand about changes over time in how the behaviors and experiences viewed today as mental illnesses/disorders/diseases have been seen and the twisting paths by which they’ve come to be portrayed in the way they have, the more contingent and constructed the current batch of diagnoses and the “symptoms” used to define them show themselves to be. More generally, this context helps us to appreciate the brain-disease model as a historically bound product of its time, and to appreciate its similarities with previous models of mental problems and the similar confidence with which previous treatments were promoted.

In fact, it’s been quite frequent in the history of psychiatry that new alleged treatments have been developed and propagated, models of the “illness” have been developed to fit with whatever the treatment affects, and a widespread belief that a powerful understanding and cure have been found has emerged. An attitude of extreme arrogance and repeated lapses in scientific humility characterize the history of the psychiatric profession, its models, and its treatments, and in light of this history and contemporary scientific challenges the claim that the dark days of false models and ineffective and harmful treatments are well in the past looks highly dubious.

We should recognize that the acceptance of the biomedical model and drug-based approach are themselves the result of a social movement within and beyond the psychiatric profession. What distinguishes this model and form of treatment from earlier ones, driving its cultural acceptance, is the increased weight of corporations and their sophisticated propaganda in recent decades. This is even more apparent when this history is understood cross-culturally. With this broader field of vision, we can recognize the diversity of understandings of and responses to psychological distress across cultures. When we look at the spread of the biopsychiatric model around the world, we see how other understandings of mental suffering are being pushed out as giant corporations and doctors connected to powerful governments impose their reductionistic model of human distress. It’s an aspect of cultural imperialism that goes beyond consumerism, shaping how people understand themselves, their relationships, and their suffering.

Not only outside the West but in some of the richest Western nations, these corporations and the health professionals who support this model wield a great deal of power, including the power to influence government choices about what to treat and how,* to influence legal systems, and to coercively administer the drugs to people in vulnerable groups (including children, young people in group homes, military personnel, people in need of government aid, and old people in facilities, amongst others). Nonvoluntary drugging, especially of children, is a key issue for psych and human rights groups. Corporations and psychiatric researchers also have great power in research settings – over both humans and nonhuman animals – and psychiatric drug research has a terrible history of abuses.

Given that we live in a hierarchical world, this model hasn’t been applied with perfect evenness or equally harmful to all social categories. The history of psychiatric “science” is replete with racism, sexism, homophobia, transphobia, and classism. This is true of the nature of the diagnoses at any given moment, of the way these diagnoses are applied, and of the treatments used. In this sense, psychiatry has conformed with and perpetuated unjust social systems.

In light of the notion of mental distress reflecting a biological abnormality or disease, in some cases argued to be genetic, psychiatry’s (ever-changing) diagnostic labels have proven, with a few limited and ambiguous exceptions, to be stigmatizing. There’s been a global campaign for many years to destigmatize “mental illness,” well-meaning on the part of most advocacy groups and more cynical on the part of the drug companies who want more people to accept the labels as this would make them more open to taking the drugs themselves or drugging their children. This contributes to the problem, though, in that it encourages the acceptance of a model of mental experiences and problems that is both unfounded and itself inherently stigmatizing. So even with a parallel – and largely ineffective - campaign for “acceptance,” the stigmatizing nature of the model remains. (It isn’t the case, as some claim, that in terms of stigma it constitutes a relative improvement over all other understandings; quite the contrary, in fact.) And the drug manufacturers, moreover, continue to medicalize all sorts of problems and experiences, leading people to view as abnormal or pathological what was previously seen as normal, unproblematic, or even positive.

Also of great importance are the negative political-economic effects of this model. Historically, psychiatry has often participated in oppression, and not only in Communist regimes where dissidents were labeled insane, confined, and forcibly drugged. Intersecting with other axes of oppression and marginalization, the mental illness axis has served to control, stigmatize, and devalue resistance, criticism, and activism. More broadly, the brain disease model doesn’t just reflect a hyper-individual culture; it profoundly depoliticizes mental suffering.In Fromm’s terms, of course, this would be an example of psychiatry’s setting aside humanistic values to serve the status quo. In a general sense, it encourages people to view their and others’ distress not in terms of a response to (and possibly critique of) their social world but as an individual sickness or flaw – that is, in the best terms for capitalist society and the need for people to “function” within it.

In this post, I’ve tried to make a case for why psychiatry and psychiatric drugs should be a priority for skeptics and social justice advocates. I’ve noted the nonexistence of a solid scientific basis for the mental illness brain-disease model and the evidence against it, the poor performance of the drugs (and certainly the failure to demonstrate a positive risk profile), and the role of pharmaceutical companies in distorting science and misleading the public. I’ve pointed to the historical and cross-cultural contexts which reveal this model to be another culturally-specific set of beliefs and practices spreading globally by way of a movement backed by powerful Western interests. I’ve discussed the social and legal power of corporations and the psychiatric profession, especially with regard to vulnerable populations, and the history of abuses in treatment and in research. I’ve also raised the issues of how this model has stigmatized people, reflected and reinforced inequalities, and served the political and economic status quo. I believe this all points to why contemporary psychiatry should be regarded as suspect and also why there’s a pressing social need for the application of skepticism to psychiatric practice.

I’ll note that in addition to the direct and indirect harm they cause to people, the actions of these companies and the psychiatrists who push the biomedical model do very real harm to the scientific-epistemic movement and to medicine. We as skeptics have the responsibility to not take it on authority that what’s sold as solid science really is and to investigate each claim in light of all of the relevant evidence. Promoting and defending this model and form of treatment as equivalent to models of diseases that are well understood and demonstrably effective treatments will only compromise the reputation of science and medicine, and of skepticism, in the long run.

*At great public expense. Further, the more people and governments buy into this expensive, drug-dominated model, the more corporate power in every sense is enhanced.

Sunday, June 17, 2012

I think sexism, misogyny, and harassment of women, including in this community, are real problems that need to be addressed,

you should stop there and consider what you’re actually doing and could be doing to counter them and how you might be contributing to them. If you then say

…BUT feminists really shouldn’t talk publicly about their experiences, shouldn’t write blog posts about the subject, shouldn’t object to slurs, shouldn’t take sexually violent language seriously, shouldn’t be angry, should name names, shouldn’t name names, shouldn’t call out any man who’s ever done anything to support women, shouldn’t call out any man who considers himself their ally, shouldn’t call out prominent men, should only discuss prominent men, shouldn’t call out women who say misogynistic things, shouldn’t call out young people, shouldn’t organize events focusing on women, should mute their criticisms to protect skeptical organizations or events, shouldn’t talk about what’s said on Facebook, shouldn’t talk about what’s said on Twitter, shouldn’t talk about what’s said on YouTube, shouldn’t turn a skeptical eye to sexist “science,” should let their experiences go unexpressed because other women have it worse, should be more polite, should be less polite, should painstakingly qualify their every statement to make it less likely to be misconstrued by those with hostile intent, should calmly describe the entire history of the arguments to everyone who jumps into them ignorant of the context, should give the benefit of the doubt to every guy who’s done or said something sexist, should frame the issues in this or that way, shouldn’t talk about patriarchy, shouldn’t talk about privilege, shouldn’t talk about rape culture, should constantly and patiently explain sociological concepts to their interlocutors, should only discuss problems that affect them personally, shouldn’t work to change official policies, should only work through official organizational channels, should only focus on this or that part of the problem, should never analogize their situation or women’s oppression to anything else, should be more aggressive, should be less aggressive, shouldn’t insult people, shouldn’t ban commenters from their blogs, shouldn’t strenuously object to mischaracterizations of their statements,…,

you should realize that this belies your claim to caring about the problems and wanting to help address them, and recognize that you are contributing to the problem. If you insist on your preconditions for listening to and supporting feminists in their struggles against sexism and misogyny, you’re acting in a way that is harmful to the cause you claim to support.

In their defense of involuntary commitment, in The Reality of Mental Illness, Martin Roth and Jerome Kroll make an important point:

‘Since most people agree that civil commitment, i.e. involuntary incarceration of a person who has not committed a crime, and involuntary treatment (based upon what others believe is best for a person) represent massive [their emphasis] infringements of that person’s civil liberties and personal integrity, it follows that the factual basis and the ethico-legal justification for such a course must be suitably strong and unambiguous’.6

According to Roth and Kroll, if psychiatrists are ever going to be able to justify their role in such ‘massive infringements’ of civil liberty we will need to be very confident that our science is disinterested and robust and that our treatments are transparently effective. We will need to be confident that we can predict outcomes, and happy that we understand how our treatments work and for whom. Furthermore, we will need to be very clear that the benefit of these treatments completely outweighs their negative effects. Remember, no other branch of medicine has the power that psychiatry possesses. We will need to be at least as confident as the rest of medicine about the veracity of our science if we are to justify this power. Do we have such a science?

…[R]ecent metaanalyses [of research on antidepressants] represent not only a challenge to our prescribing but also question the foundations of contemporary psychiatric science itself. Rather than embrace the therapeutic reality and the theoretical implications of the placebo phenomenon and explore ways of incorporating these positively and transparently, a number of prominent psychiatrists have sought to justify current prescribing practices by dismissing the results of these meta-analyses. Some of them have done so by arguing that we should abandon the evidence-based medicine (EBM) approach. They say something like: ‘actually science isn’t that important in debates about psychopharmacology, what is really important is the experience of the doctor’. So we hear one prominent psychopharmacologist, MacAllister Williams, insisting that: ‘it matters little whether the patient responds due to the placebo effect or the specific pharmacological actions of the drug, as long as they get better’.11

But the whole logic of EBM, of double blind controlled trials, is to identify what part of therapeutic improvement is due to the placebo response. MacAllister Williams is telling us that this is not important: we know how to get our patients better with antidepressants and that is all that matters.

The psychiatric discourse around antidepressants is far from the ‘strong and unambiguous science’ demanded by Roth and Kroll. Is the science of anti-psychotics any more robust? The development of second generation antipsychotics was heralded as one of the great achievements of modern psychopharmacology. For many years after their introduction, psychiatrists told patients and relatives how safe and effective these drugs were. There was talk about a ‘breakthrough’ in the treatment of schizophrenia. Several years on, and the picture does not look so rosy. We now know that these drugs are possibly more toxic than the earlier ones and there is no evidence that they are more effective. Furthermore, in a major paper in the Lancet last year, evidence was presented to show that even the notion that these drugs represented a significantly different grouping was false.12 In an editorial comment on this paper, Peter Tyrer and Tim Kendall wrote: ‘The spurious invention of the atypicals can now be regarded as invention only, cleverly manipulated by the drug industry for marketing purposes and only now being exposed. But how is it that for nearly two decades we have, as some have put it, “been beguiled” into thinking they were superior?’.13

Antidepressants and antipsychotics are cornerstones of psychopharmacology. These are the drugs that are administered to patients when they are detained. Psychopharmacology is the usual form of treatment given to patients on an involuntary basis.

My argument is that the science we have available to us now, with its explanations and treatments, is simply not of the standard set by Roth and Kroll to justify the power that psychiatrists have been given. [emphasis added]

Thursday, June 7, 2012

I've mentioned several times here that the best place to go for Honduras news and analysis is Adrienne Pine's Quotha (the first of the Honduras links to the left). Pine provides on-the ground coverage of the Honduran resistance movement, as well as critical analysis of events there, media (mis)representations, and the policies and actions of the US and Canadian governments and corporations.

Here are three recent articles posted there that provide information on recent events with valuable political context and historical background:

94 Congress Members, hundreds of academics from Honduras and around the world, dozens of high-profile human rights and press freedom organizations, and citizens from Honduras and the U.S. are demanding the same thing of the Obama administration: stop funding and training the murderous Honduran police and military, and stop killing innocent Hondurans in the name of the War on Drugs. In the wake of the DEA-led massacre of pregnant women and children in the Moskitia, it is high time this administration start listening to citizens and experts. Rather than starting another unwinnable war against people in a nation ruled by a U.S. supported, coup-installed president, the U.S. should be spending its resources on shoring up our own democracy.

The UN's special rapporteur on torture has made a formal approach to the US government over a special-needs school near Boston that inflicts electric shocks on autistic children as a form of behavioural control.

Juan Mendez has told the Guardian that he has opened discussions with the US mission to the UN in Geneva as a first step towards investigating the school.

The rapporteur plans to contact the US state department and has the option of reporting the matter to the UN human rights council.

Mendez said he was "very concerned" about the use of electric shocks, which are inflicted on autistic children through pads applied to their skin.

"The use of electricity on anyone's body raises the question of whether this is therapeutic or whether it inflicts pain and suffering tantamount to torture in violation of international law," he added....

The report does note: "As public anger builds, there are mounting political moves to restrict the school's activities. A bill that would ban aversive therapy has already passed the Massachusetts state senate and is now being considered by the house."

Senator Chuck Grassley is asking the National Institutes of Health to explain why it has awarded a $400,000 medical research grant to a physician who it banned from NIH funding in recent years for failing to disclose a $1.2 million financial relationship with a major pharmaceutical company while leading a $9 million federal study involving that drug company’s blockbuster depression drug Paxil.

“It’s troubling that NIH continues to provide limited federal dollars to individuals who have previously had grant funding suspended for failure to disclose conflicts of interest and even more troubling that the Administration chose not to require full, open and, public disclosure of financial interests on a public website,” Grassley wrote to NIH Director Francis Collins.

...In 2008, documents revealed that [Dr. Charles B.] Nemeroff, who was then chair of Emory University’s psychiatry department, failed to disclose that he received $1.2 million in consulting fees from GlaxoSmithKline, the maker of Paxil, while leading federal research on the treatment of depression. Nemeroff left Emory University and was then hired by Miami University. The Director of the National Institute of Mental Health within NIH weighed in on Nemeroff taking this new position. While the NIH said that Nemeroff could not receive federal medical research dollars for two years, the ban has expired and, regardless, it did not apply to him in a position at a new university.

In addition, Nemeroff remains under investigation by the Inspector General for the Department of Health and Human Services, which is working with the Department of Justice on the case. In his letter today, Grassley asked the NIH if this was considered. "There has been no final resolution by DOJ or public finding by HHS OIG related to the investigation of Dr. Nemeroff. Yet, NIH awarded him another grant,” he said.

Take a good look into yourself, and if you love Things and the power and the plenitude of Things better than you love your own dignity, human dignity, Oh, say so, say so! Say it to yourself, and abide by it. But do not blow hot and cold in one breath. Do not try to be a social reformer and a respected possessor of Things at the same time. Do not preach the straight and narrow way while going joyously upon the wide one. Preach the wide one, or do not preach at all; but do not fool yourself by saying you would like to help usher in a free society, but you cannot sacrifice an armchair for it. Say honestly, "I love arm-chairs better than free men, and pursue them because I choose; not because circumstances make me. I love hats, large, large hats, with many feathers and great bows; and I would rather have those hats than trouble myself about social dreams that will never be accomplished in my day. The world worships hats, and I wish to worship with them."